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Cited by 179Ocular Infections and TreatmentsIntraocular Surgery and LensesSurgical site infection prevention

Endophthalmitis Reduction with Intracameral Moxifloxacin Prophylaxis

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Haripriya, Aravind, Chang, David F., Ravindran, Ravilla D.·2017·Ophthalmology
DOI 10.1016/j.ophtha.2017.01.026
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Abstract

Purpose To compare the postoperative endophthalmitis rate before and after initiation of intracameral (IC) moxifloxacin prophylaxis for both phacoemulsification and sutureless, manual small-incision cataract surgery (M-SICS), as well as in patients with posterior capsular rupture (PCR).Design Retrospective, clinical registry.Participants All cataract surgeries (617 453) performed during the 29-month period from January 2014 to May 2016 at the 10 regional Aravind eye hospitals were included.Methods The electronic health record data for all study eyes were analyzed. Endophthalmitis rates before and after moxifloxaxin were statistically compared for all eyes and separately for both phacoemulsification and M-SICS, and for the eyes complicated by PCR.Main outcome measures The postoperative endophthalmitis rates before and after initiation of IC moxifloxacin prophylaxis.Results Overall, 302 815 eyes did not receive IC moxifloxacin and 314 638 eyes did, and there was a significant decline in the endophthalmitis rate, from 0.07% (214/302 815) to 0.02% (64/314 638) (P < 0.001), with moxifloxacin. For the 194 252 phacoemulsification eyes, the endophthalmitis rate was 0.07% (75/104 894) without IC moxifloxacin prophylaxis, compared with 0.01% (11/89 358) with moxifloxacin (P < 0.001). For the 414 657 M-SICS eyes, the endophthalmitis rate was 0.07% (135/192 149) without IC moxifloxacin prophylaxis, compared with 0.02% (52/222 508) with moxifloxacin (P < 0.001). Approximately half of the 8479 eyes that had PCR received IC moxifloxacin, and half did not. Without IC moxifloxacin, PCR increased the endophthalmitis rate nearly 7-fold to 0.48% (20/4186); IC moxifloxacin reduced the endophthalmitis rate with PCR to 0.21% (9/4293) (P = 0.034). No adverse events were due to IC moxifloxacin.Conclusions Routine IC moxifloxacin prophylaxis reduced the overall endophthalmitis rate by 3.5-fold (3-fold for M-SICS and nearly 6-fold for phacoemulsification). There was also a statistical benefit for eyes complicated by PCR, and IC antibiotic prophylaxis should be strongly considered for this high-risk population. These conclusions are strengthened by the high volume of cases analyzed at a single hospital network over a comparatively short time frame. Considering the association of hemorrhagic occlusive retinal vasculitis with vancomycin and the commercial unavailability of IC cefuroxime in many countries, moxifloxacin appears to be an effective option for surgeons electing IC antibiotic prophylaxis.

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  • Endophthalmitis studies at Aravind Eye Care System raise the possibility that many costly and wasteful infection control protocols used by operating rooms in the United States could be unnecessary.

    “Endophthalmitis studies at Aravind Eye Care System raise the possibility that many of the costly and wasteful infection control protocols used by operating rooms in the United States could be unnecessary.39”

    From How Ophthalmologists Can Decarbonize Eye Care (2023) · cites this paper as [39]

    The discussion of cost-saving practices (page not provided) reports a low endophthalmitis rate at Aravind despite reuse of supplies that would not be allowed in North America. That raises the possibility behind the claim, but the paper does not assess US operating-room protocols or establish that many are costly, wasteful, or unnecessary. (LLM, conf=0.83)

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  • There is substantial variability in waste generation and emissions from cataract surgery in different countries, suggesting improvements are possible.

    “There is substantial variability in waste generation and emissions from cataract surgery in different countries, suggesting improvements are possible.29,33,39”

    From How Ophthalmologists Can Decarbonize Eye Care (2023) · cites this paper as [39]

    The discussion (section labeled “z”; page unavailable) says that disposable supplies are reused at the Indian hospitals and that some cost-saving practices would not be allowed in North America or Western Europe. It does not compare cataract-surgery waste generation or emissions across countries. Searches for waste, emissions, and carbon footprint found no passage addressing that claim. (LLM, conf=0.74)

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Research works printed but not linked: 3

  1. [3]3. Barry P, Seal DV, Gettinby G, et al. ESCRS study of pro- phylaxis of postoperative endophthalmitis after cataract sur- gery: preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006;32:407-410.
  2. [5]5. Lundström M, Wejde G, Stenevi U, et al. Endophthalmitis after cataract surgery: a nationwide prospective study evalu- ating incidence in relation to incision type and location. Ophthalmology. 2007;114:866-870.
  3. [13]13. Jabbarvand M, Hashemian H, Khodaparast M, et al. Endophthalmitis occurring after cataract surgery: outcomes of more than 480 000 cataract surgeries, epidemiologic features, and risk factors. Ophthalmology. 2016;123:295-301.

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Authors
Haripriya, A., Chang, D. F., & Ravindran, R. D.
Affiliations
Aravind Eye Hospital (IN)
Corresponding author
Haripriya, Aravind
ORCID
Venue
Ophthalmology
Publisher
Elsevier BV
Published
2017-06
Volume
124
Issue
6
Pages
768-775
ISSN
0161-6420 (ISSN-L)
DOI
10.1016/j.ophtha.2017.01.026
OpenAlex
W2588997827
Cited by
179
References
43
Citations by year
2026: 14 · 2025: 14 · 2024: 9 · 2023: 15 · 2022: 14 · 2021: 26 · 2020: 34 · 2019: 11 · 2018: 22 · 2017: 19 · 2014: 1
FWCI
23.05
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Ophthalmology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
  • Health Sciences › Medicine › Ophthalmology › Intraocular Surgery and Lenses
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
Keywords
endophthalmitis, intracameral moxifloxacin, antibiotic prophylaxis, cataract surgery, phacoemulsification, manual small incision cataract surgery, posterior capsule rupture, postoperative infection, surgical site infection, cataract complications, Aravind Eye Hospital, India, resource-limited settings, surgical quality improvement
MeSH terms
Moxifloxacin, Aged, Anterior Chamber, Anti-Bacterial Agents, Cataract Extraction, Female, Humans, India, Male, Microsurgery, Middle Aged, Endophthalmitis, Ophthalmic Solutions, Postoperative Complications, Registries, Retrospective Studies, Eye Infections, Bacterial, Phacoemulsification, Antibiotic Prophylaxis, Lens Implantation, Intraocular, Fluoroquinolones, Electronic Health Records, Posterior Capsular Rupture, Ocular

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